Provider Demographics
NPI:1922866896
Name:THOMPSON, CAITLIN CHRISTINE (LCMHC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:CHRISTINE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3143 S STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5948
Mailing Address - Country:US
Mailing Address - Phone:336-893-9705
Mailing Address - Fax:
Practice Address - Street 1:3143 S STRATFORD RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5948
Practice Address - Country:US
Practice Address - Phone:336-893-9705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health